Chapter 8

_Symptoms._--The symptoms vary somewhat according to the position of the body causing choke. In pharyngeal choke the object is lodged in the upper portion of the esophagus. The horse will present symptoms of great distress, hurried breathing, frequent cough, excessive flow of saliva, sweating, trembling, or stamping with the fore feet. The abdomen rapidly distends with gas. The diagnosis is completed by manipulating the upper part of the throat from without and by the introduction of the hand into the back part of the mouth, finding the body lodged here. In cervical choke (where the obstruction is situated at any point between the throatlatch and the shoulder) the protrusion caused by the object can be seen and the object can be felt. The symptoms here are not so severe; the horse will be seen occasionally to draw himself up, arch his neck, and make retching movements as though he wished to vomit. The abdomen may be tympanitic. Should there be any question as to the trouble, a conclusion may be reached by pouring water into the throat from a bottle. If the obstruction is complete, by standing on the left side of the horse and watching the course of the esophagus, you can see the gullet, just above the windpipe, become distended with each bottle of water. This is not always a sure test, as the obstruction may be an angular body, in which case liquids would pass it. Solids taken would show in these cases; solids should not, however, be given, as they serve to increase the trouble by rendering the removal of the body more difficult.

In thoracic choke the symptoms are less severe. Feed or water may be ejected through the nose or mouth after the animal has taken a few swallows. There will be some symptoms of distress, fullness of the abdomen, cough, and occasionally retching movements. Sometimes a choking horse is heard to emit groans. The facial expression always denotes great anxiety and the eyes are bloodshot. The diagnosis is complete if, upon passing the probang (a flexible tube made for this purpose), an obstruction is encountered.

_Treatment._--If the choke is at the beginning of the gullet (pharyngeal) an effort must be made to remove the obstacle through the mouth. A mouthgag, or speculum, is to be introduced into the mouth to protect the hand and arm of the operator. Then, while an assistant, with his hands grasped tightly _behind_ the object, presses it upward and forward with all his force, the operator must pass his hand into the mouth until he can seize the obstruction and draw it outward. This mode of procedure must not be abandoned with the first failure, as by continued efforts we may get the obstacle farther toward the mouth. If we fail with the hand, forceps may be introduced through the mouth and the object seized when it is just beyond the reach of the fingers. Should our efforts entirely fail, we must then endeavor to force the obstruction downward by means of the probang. This instrument, which is of such signal service in removing choke in cattle, is decidedly more dangerous to use for the horse, and I can not pass this point without a word of caution to those who have been known to introduce into the horse's throat such objects as whipstalks, shovel handles, etc. These are always dangerous, and more than one horse has been killed by such barbarous treatment.

In cervical as well as in thoracic choke we must first of all endeavor to soften or lubricate the obstruction by pouring oil or mucilaginous drinks down the gullet. After this has been done endeavor to move the object by gentle manipulations with the hands. If choked with oats or chaff (and these are the objects that most frequently produce choke in the horse), begin by gently squeezing the lower portion of the impacted mass and endeavor to work it loose a little at a time. This is greatly favored at times if we apply hot fomentations immediately about the obstruction. Persist in these efforts for at least an hour before deciding to resort to other and more dangerous modes of treatment. If unsuccessful, however, the probang may be used. In the absence of the regular instrument, a piece of inch hose 6 feet long or a piece of new three-quarter-inch manila rope well wrapped at the end with cotton twine and thoroughly greased with tallow should be used. The mouth is to be kept open by a gag of wood or iron and the head slightly raised and extended. The probang is then to be carefully guided by the hand into the upper part of the gullet and gently forced downward until the obstruction is reached. Pressure must then be gradual and firm. At first too much force should not be used, or the esophagus will be ruptured. Firm, gentle pressure should be kept up until the object is felt to move, after which it should be followed rapidly to the stomach. If this mode of treatment is unsuccessful, a veterinarian or a physician should be called, who can remove the object by cutting down upon it. This should scarcely be attempted by a novice, as a knowledge of the anatomy of the parts is essential to avoid cutting the large artery, vein, and nerve that are closely related to the esophagus in its cervical portion.

Thoracic choke can be treated only by means of the introduction of oils and mucilaginous drinks and the careful use of the probang.

STRICTURE OF THE ESOPHAGUS.

This is due to corrosive medicines, previous choking (accompanied with lacerations, which, in healing, narrow the passage), or pressure on the gullet by tumors. In the majority of cases of stricture, dilatation of the gullet in front of the constricted portion soon occurs. This dilatation is the result of the frequent accumulation of solid feed above the constriction. Little can be done in either of these instances except to give sloppy or liquid feed.

SACULAR DILATATION OF THE ESOPHAGUS.

This follows choking, and is due to stretching or rupture of the muscular coat of the gullet, allowing the internal, or mucous, coat to protrude through the lacerated muscular walls. Such a dilatation, or pouch, may gradually enlarge from the frequent imprisonment of feed. When liquids are taken, the solid materials are partially washed out of the pouch.

The symptoms are as follows: The horse is able to swallow a few mouthfuls without apparent difficulty; then he will stop feeding, paw, contract the muscles of his neck, and eject a portion of the feed through his nose or mouth, or it will gradually work down to the stomach. As the dilatation thus empties itself the symptoms gradually subside, only to reappear when he has again taken solid feed. Liquids pass without any, or but little, inconvenience. Should this dilatation exist in the cervical region, surgical interference may sometimes prove effectual; if in the thoracic portion, nothing can be done, and the patient rapidly passes from hand to hand by "swapping," until, at no distant date, the contents of the sac become too firm to be dislodged as heretofore, and the animal succumbs.

DISEASES OF THE STOMACH AND INTESTINES.

As a rule it is most difficult to distinguish between diseases of the stomach and of the intestines of the horse. The reason for this is that the stomach is relatively small. It lies away from the abdominal wall, and so pressure from without can not be brought to bear upon it to reveal sensitiveness or pain. Nor does enlargement, or distention, of the stomach produce visible alteration in the form of the abdomen of the horse. Moreover, it is a rule to which there are few exceptions, that an irritant or cause of disease of the stomach acts likewise upon the intestines, so that it is customary to find them similarly deranged. For these reasons it is logical to discuss together the diseases of the stomach and intestines and to point out such localizations in one organ or another as are of importance in recognizing and treating the diseases of the digestive organs of the horse.

It should be understood that gastritis signifies an inflammation of the stomach and enteritis an inflammation of the intestines. The two terms may be used together to signify a disease of the stomach and intestines, as gastro-enteritis.

COLIC.

The disease of the horse that is most frequently met with is what is termed "colic," and many are the remedies that are reputed to be "sure cures" for this disease. Let us discover, then, what the word "colic" means. This term is applied loosely to almost all diseases of the organs of the abdomen that are accompanied with pain. If the horse evinces abdominal pain, he probably will be considered as suffering with colic, no matter whether the difficulty is a cramp of the bowel, an internal hernia, overloading of the stomach, or a painful disease of the bladder or liver. Since these conditions differ so much in their causation and their nature, it is manifestly absurd to treat them alike and to expect the same drugs or procedures to relieve them all. Therefore, it is important that, so far as possible, the various diseased states that are so roughly classed together as colic shall be separated and individualized in order that appropriate treatments may be prescribed. With this object in view, colics will be considered under the following headings: (1) Engorgement colic, (2) obstruction colic, (3) flatulent or tympanitic colic, (4) spasmodic colic. Worm colic is discussed under the heading "Gastrointestinal parasites," page 90.

The general symptoms of abdominal pain, and therefore of colic, are restlessness, cessation of whatever the horse is about, lying down, looking around toward the flank, kicking with the hind feet upward and forward toward the belly, jerky switching of the tail, stretching as though to urinate, frequent change of position, and groaning. In the more intense forms the horse plunges about, throws himself, rolls, assumes unnatural positions, as sitting on the haunches, and grunts loudly. Usually the pain is not constant, and during the intermissions the horse may eat and appear normal. During the period of pain sweat is poured out freely. Sometimes the horse moves constantly in a circle. The respirations are accelerated, and usually there is no fever.

ENGORGEMENT COLIC.--This form of colic consists in an overloading of the stomach with feed. The horse may have been overfed or the feed may have collected in the stomach through failure of this organ to digest it and pass it backward into the intestines. Even a normal quantity of feed that the horse is unaccustomed to may cause disease. Hence a sudden change of feed may produce engorgement colic. Continued full rations while the horse is resting for a day or two or working too soon after feeding may serve as a cause. New oats, corn, or hay, damaged feed, or that which is difficult of digestion, such as barley or beans, may incite engorgement colic. This disease may result from having fed the horse twice by error or from its having escaped and taken an unrestricted meal from the grain bin. Ground feeds that pack together, making a sort of dough, may cause engorgement colic if they are not mixed with cut hay. Greedy eaters are predisposed to this disease.

_Symptoms._--The horse shows the general signs of abdominal pain, which may be long continued or of short duration. Retching or vomiting movements are made; these are shown by labored breathing, upturned upper lip, contraction of the flank, active motion at the throat, and drawing in of the nose toward the breast, causing high arching of the neck. The horse may assume a sitting position like a dog. At times the pain is very great and the horse makes the most violent movements, as though mad. At other times there is profound mental depression, the horse standing in a sleepy, or dazed, way, with the head down, the eyes closed, and leaning his head against the manger or wall. There is, during the struggles, profuse perspiration. Following retching, gas may escape from the mouth, and this may be followed by a sour froth and some stomach contents. The horse can not vomit except when the stomach is violently stretched, and, if the accumulation of feed or gas is great enough to stretch the stomach so that vomiting is possible, it may be great enough to rupture that organ. So it happens not infrequently that a horse dies from ruptured stomach after vomiting. After the stomach ruptures, however, vomiting is impossible. The death rate in this form of colic is high.

_Treatment._--The bowels should be stimulated to contraction by the use of clysters of large quantities of water and of glycerin. Veterinarians use hypodermic injections of eserin or arecolin or intravenous injections of barium chlorid, but they must be employed with great caution. It is not profitable to give remedies by the stomach, for they can not be absorbed. But small doses of morphin (5 grains) or of the fluid extract of Indian hemp (2 drams) may be placed in the mouth and are absorbed in part, at least, without passing to the stomach. These drugs lessen pain and thus help to overcome the violent movements that are dangerous, because they may be the means of causing rupture of the diaphragm or stomach. If facilities are available, relief may be afforded by passing an esophageal tube through which some of the gaseous and liquid contents of the stomach may escape.

_Rupture of the stomach._--This mostly occurs as a result of engorged or tympanitic stomach (engorgement colic) and from the horse violently throwing himself when so affected. It may result from disease of the coats of the stomach, gastritis, stones (calculi), tumors, or anything that closes the opening of the stomach into the intestines, and very violent pulling or jumping immediately after the animal has eaten heartily of bulky feed. These or similar causes may lead this accident.

The symptoms of rupture of the stomach are not constant or always reliable. Always make inquiry as to what and how much the horse has been fed at the last meal. Vomiting may precede rupture of this organ, as stated above. This accident appears to be most liable to occur in heavy draft horses. A prominent symptom observed (though it may also occur in diaphragmatic hernia) is when the horse, if possible, gets the front feet on higher ground than the hind ones or sits on his haunches, like a dog. This position affords relief to some extent, and it will be maintained for several minutes; it is also quickly regained when the horse has changed it for some other. Colicky symptoms, of course, are present, which vary much and present no diagnostic value. As the case progresses the horse will often stretch forward the fore legs, lean backward and downward until the belly nearly touches the ground, and then rise up again with a groan, after which the fluid from his nostrils is issued in increased quantity. The pulse is fast and weak, breathing hurried, body bathed in a clammy sweat, limbs tremble violently, the horse reels or staggers from side to side, and death quickly ends the scene.

In the absence of any pathognomonic symptom we must consider the history of the case; the symptoms of colic that cease suddenly and are succeeded by cold sweats and tremors; the pulse quick and small and thready, growing weak and more frequent, and at length running down and becoming altogether imperceptible; looking back at the flank and groaning; sometimes crouching with the hind quarters; with or without eructation and vomiting.

There is no treatment that can be of any use whatever. Could we be sure of our diagnosis it would be better to destroy the animal at once. Since, however, there is always the possibility of a mistake in diagnosis, we may give powdered opium in 1-dram doses every two or three hours, with the object of keeping the stomach as quiet as possible.

OBSTRUCTION COLIC.--The stomach or bowels may be obstructed by accumulations of partly digested feed (fecal matter), by foreign bodies, by displacements, by paralysis, or by abnormal growths.

_Impaction of the large intestines._--This is a very common bowel trouble and one which, if not promptly recognized and properly treated, results in death. It is caused by overfeeding, especially of bulky feed containing an excess of indigestible residue; old, dry, hard hay, or stalks when largely fed; deficiency of secretions of the intestinal tracts; lack of water; want of exercise, medicines, etc.

Impaction of the large bowels is to be diagnosed by a slight abdominal pain, which may disappear for a day or two to reappear with more violence. The feces are passed somewhat more frequently, but in smaller quantities and drier; the abdomen is full, but not distended with gas; the horse at first is noticed to paw and soon begins to look back at his sides. Probably one of the most characteristic symptoms is the position assumed when down. He lies flat on his side, head and legs extended, occasionally raising his head to look toward his flank; he remains on his side for from five to fifteen minutes at a time. Evidently this position is the one giving the most freedom from pain. He rises at times, walks about the stall, paws, looks at his sides, backs up against the stall, which he presses with his tail, and soon lies down again, assuming his favored position. The intestinal sounds, as heard by applying the ear to the flank, are diminished, or there is no sound, indicating absence of motion of the bowels. The bowels may cease entirely to move. The pressure of the distended intestine upon the bladder may cause the horse to make frequent attempts to urinate. The pulse is but little changed at first, being full and sluggish; later, if this condition is not overcome, it becomes rapid and feeble. Horses may suffer from impaction of the bowels for a week, yet eventually recover, and cases extending two or even three weeks have ended favorably. As a rule, however, they seldom last more than four or five days, many, in fact, dying sooner than this.

The treatment consists of efforts to produce movement of the bowels and to prevent inflammation of the same from arising. A large cathartic is to be given as early as possible. Either of the following is recommended: Powdered Barbados aloes 1 ounce, calomel 2 drams, and powdered nux vomica 1 dram; or linseed oil 1 pint and croton oil 15 drops; or from 1 pint to 1 quart of castor oil may be given. Some favor the administration of Epsom or Glauber's salt, 1 pound, with one-quarter pound of common salt, claiming that this causes the horse to drink largely of water, thus mechanically softening the impacted mass and favoring its expulsion. Whichever physic is selected, it is essential that a full dose be given. This is much better than small and repeated doses. It must be borne in mind that horses require about twenty-four hours in which to respond to a physic, and under no circumstances is it to be repeated sooner. If aloes has been given and has failed to operate at the proper time, oil or some different cathartic should then be administered. Allow the horse all the water he will drink. Calomel may be administered in half-dram doses, the powder being placed on the tongue, one dose every two hours until four doses are given.

Enemas of glycerin, 2 to 4 ounces, are often beneficial. Rubbing or kneading of the abdominal walls and the application of stimulating liniments or strong mustard water also, at times, favor the expulsion of this mass. Walking exercise must occasionally be given. If this treatment is faithfully carried out from the start the majority of cases will terminate favorably. When relief is not obtained inflammation of the bowels may ensue and cause death.

_Constipation, or costiveness._--This is often witnessed in the horse, and particularly in the foal. Many colts die every year from failure on the part of the attendant to note the condition of the bowels soon after birth. Whenever the foal fails to pass any feces, and in particular if it presents any signs of colicky pains--straining, etc.--immediate attention must be given it. As a rule, it will be necessary only to give a few injections of soapy water in the rectum and to introduce the finger through the anus to break down any hardened mass of dung found there. If this is not effective a purgative must be given. Oils are the best for these young animals, and preferably castor oil, giving from 2 to 4 ounces. The foal should always get the first of the mother's milk, which, for a few days, possesses decidedly laxative properties. If a mare, while suckling, is taking laudanum, morphin, atropia, or similar medicines, the foal during this time should be fed by hand and the mare milked upon the ground. Constipation in adult horses is often the result of long feeding on dry, innutritious feed, deficiency of intestinal secretions, scanty water supply, or lack of exercise. If the case is not complicated with colicky symptoms a change to light, sloppy diet, linseed gruel or tea, with plenty of exercise, is all that is required. If colic exists a cathartic is needed. In very many instances the constipated condition of the bowels is due to lack of intestinal secretions, and when so caused may be treated by giving fluid extract of belladonna in 2-dram doses three times a day and handful doses of Epsom salt daily in the feed. It is always best, when possible, to overcome this trouble by a change of diet rather than by the use of medicines. For the relief of constipation such succulent feeds as roots, grass, or green forage are recommended. Silage, however, should be fed sparingly, and not at all unless it is in the very best condition. Moldy silage may cause fatal disease.

_Foreign bodies (calculi, stones) in the stomach._--There are probably but few symptoms exhibited by the horse that will lead one to suspect the presence of gastric calculi, and possibly none by which we can unmistakably assert their presence. They have been found most frequently in millers' horses fed sweepings from the mills. A depraved and capricious appetite is common in horses that have a stone forming in the stomachs. There is a disposition to eat the woodwork of the stable, earth, and, in fact, almost any substance within their reach. This symptom must not, however, be considered as pathognomonic, since it is observed when calculi are not present. Occasional colics may result from these "stomach stones," and when the latter lodge at the outlet of the stomach they may give rise to symptoms of engorged stomach, already described. There is, of course, no treatment that will prove effective. Remedies to move the bowels, to relieve pain, and to combat inflammation should be given.

_Intestinal concretions (calculi or stones in the intestines)._--These concretions are usually found in the large bowels, though they are occasionally seen in the small intestines. They are of various sizes, weighing from 1 ounce to 25 pounds; they may be single or multiple, and differ in composition and appearance, some being soft (composed mostly of animal or vegetable matter), while others are porous, or honeycombed (consisting of animal and mineral matter), and others are entirely hard and stonelike. The hair balls, so common to the stomach and intestines of cattle, are very rare in horses. Intestinal calculi form around some foreign body, as a rule--a nail or piece of wood--whose shape they may assume to a certain extent. Layers are arranged concentrically around such nucleus until the sizes above spoken of are attained. These stones are also often found in millers' horses, as well also as in horses in limestone districts, where the water is hard. When the calculi attain a sufficient size and become lodged or blocked in some part of the intestines, they cause obstruction, inflammation of the bowels, colicky symptoms, and death. There are no certain signs or symptoms that reveal them. Recurring colics of the type of impaction colic, but more severe, may lead one to suspect the existence of this condition. Examination through the rectum may reveal the calculus.